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Baroni M, Biagioni S, Benedetti E, Scalese M, Baldini F, Potente R, Menicucci D, Molinaro S. Non-prescribed pharmaceutical stimulants use among adolescents: A way to self-care or peer success? Drug Alcohol Depend 2023; 250:110906. [PMID: 37549544 DOI: 10.1016/j.drugalcdep.2023.110906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 07/13/2023] [Accepted: 07/15/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND the use of pharmaceutical stimulants without a medical prescription (PSWMP) among adolescents is considered an established public health issue. The present study aimed to investigate the potential links between different patterns of non-medical use of pharmaceutical stimulants, psycho-social factors, and other risky behaviours (e.g. psychoactive substance use). METHODS For this purpose, data from a sample of 14,685 adolescents aged 15-19 participating in the ESPAD®Italia 2019 study were analysed by conducting descriptive analyses and multinomial logistic regressions. RESULTS The findings highlight the key role of psycho-social factors and engagement in other risky behaviours in either reducing or promoting the risk of PSWMP use. Particularly, being satisfied with peer relationships and with oneself is significantly associated with lower use of PSWMP. Conversely, the consumption of other psychoactive substances (both legal and illegal) and engagement in other risky behaviours (e.g., gambling and cyberbullying) may increase this phenomenon. CONCLUSIONS Considering their representativeness, the results of the present study could be used as groundwork for the development of effective and targeted prevention programs and interventions.
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Affiliation(s)
- Marina Baroni
- Institute of Clinical Physiology, National Research Council of Italy, Italy; Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Italy
| | - Silvia Biagioni
- Institute of Clinical Physiology, National Research Council of Italy, Italy; Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Italy
| | - Elisa Benedetti
- Institute of Clinical Physiology, National Research Council of Italy, Italy
| | - Marco Scalese
- Institute of Clinical Physiology, National Research Council of Italy, Italy
| | - Federica Baldini
- Institute of Clinical Physiology, National Research Council of Italy, Italy; Department of Social Sciences and Economics, Sapienza University of Rome, Italy
| | - Roberta Potente
- Institute of Clinical Physiology, National Research Council of Italy, Italy
| | - Danilo Menicucci
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Italy
| | - Sabrina Molinaro
- Institute of Clinical Physiology, National Research Council of Italy, Italy.
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Gudmundsdottir BG, Reynisdottir UE, Sigurvinsdottir R, Sigfusdottir ID. Prevalence and correlates of nonmedical use of prescription stimulants among upper secondary school students in Iceland. NORDIC PSYCHOLOGY 2023. [DOI: 10.1080/19012276.2023.2177712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Affiliation(s)
| | - Unnur Elsa Reynisdottir
- Department of Psychology, Reykjavik University and Icelandic Centre for Social Research and Analysis, Reykjavik, Iceland
| | - Rannveig Sigurvinsdottir
- Department of Psychology, Reykjavik University and Icelandic Centre for Social Research and Analysis, Reykjavik, Iceland
| | - Inga Dora Sigfusdottir
- Department of Psychology, Reykjavik University and Icelandic Centre for Social Research and Analysis, Reykjavik, Iceland
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Ngo Q, Plante DT. An Update on the Misuse and Abuse Potential of Pharmacological Treatments for Central Disorders of Hypersomnolence. CURRENT SLEEP MEDICINE REPORTS 2022. [DOI: 10.1007/s40675-022-00227-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Brumbaugh S, Tuan WJ, Scott A, Latronica JR, Bone C. Trends in characteristics of the recipients of new prescription stimulants between years 2010 and 2020 in the United States: An observational cohort study. EClinicalMedicine 2022; 50:101524. [PMID: 35812998 PMCID: PMC9257326 DOI: 10.1016/j.eclinm.2022.101524] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 05/18/2022] [Accepted: 05/31/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Stimulant prescriptions increased by 250% in the United States from 2006-2016 while diagnoses for ADHD minimally increased. There is insufficient data regarding who may be the recipients of these new stimulant prescriptions and safety of stimulants have come under scrutiny in some populations. We aim to describe trends in stimulant prescriptions across biopsychosocial patient level factors between 2010 and 2020. METHODS We applied a retrospective observational cohort design utilizing electronic health records from 52 healthcare organizations sourced from the TriNetX research network database in the United States. We assessed new stimulant prescriptions across biopsychosocial variables for recipients of prescriptions. We utilized linear regression to assess longitudinal trends of all participants and also conducted an age stratified logistic regression analysis. FINDINGS There was an increase in stimulants to people categorized as white (OR 1.24 CI 1.20-1.28), female (OR 1.28 CI 1.23-1.31), and to those with diagnosed anxiety disorders (OR 1.39 CI 1.35-1.44) as well as obesity (OR 1.34 CI 1.28-1.41). The average age of recipients increased throughout the study, and among people sixty-five and older, there was an increase in prescriptions to people with multiple cardiovascular risk factors. INTERPRETATION Prescription stimulant dispensing may have liberalized during the study period in some demographics as a greater number of new prescriptions were dispensed to individuals with risk of adverse outcomes (i.e. older individuals, obese individuals, and geriatric patients with CV risk factors) between 2010 and 2020. Similar trends in prescription medications were witnessed through the opioid epidemic and warrant attention given concerning trends with illicit stimulants. Additional research that investigates patient and provider motivation for stimulant prescriptions, as well as risk perception of stimulants, may be warranted. FUNDING This study was made possible by institutional resources at Penn State Hershey Medical Center.
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Affiliation(s)
- Shannon Brumbaugh
- Penn State Hershey Medical Center, College of Medicine, Hershey, PA, USA
| | - Wen Jan Tuan
- Penn State Hershey Medical Center, Department of Family and Community Medicine, Hershey, PA, USA
| | - Alyssa Scott
- Penn State Hershey Medical Center, College of Medicine, Hershey, PA, USA
| | - James R. Latronica
- University of Pittsburgh School of Medicine, Department of Psychiatry and Department of Family Medicine, Pittsburgh, PA, USA
- Corresponding author at: University of Pittsburgh School of Medicine, Department of Psychiatry, Department of Family Medicine, 3501 Forbes Ave., Suite 860, Pittsburgh, PA 15213, USA.
| | - Curtis Bone
- Penn State Hershey Medical Center, Department of Family and Community Medicine, Hershey, PA, USA
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Malingering and Stimulant Medications Abuse, Misuse and Diversion. Brain Sci 2022; 12:brainsci12081004. [PMID: 36009067 PMCID: PMC9406161 DOI: 10.3390/brainsci12081004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 07/24/2022] [Accepted: 07/27/2022] [Indexed: 02/04/2023] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that interferes with multiple aspects of daily functioning. Malingering or feigning of symptoms can be a major challenge during ADHD assessment. Stimulant medication abuse, misuse and diversion may constitute another challenge during management. A literature search of the past 15 years on the topic continued to suggest that there are several reasons for malingering and faking ADHD symptoms. Some of the reasons include the intent to obtain prescriptions for stimulant medications for performance enhancement, to gain access to additional school services and accommodations, to use recreationally and to sell as a street drug. In some countries, patients may receive additional tax or student loan benefits. Several researchers suggested that self-report rating measures are easily simulated by patients without ADHD. They concluded that no questionnaire has proved sufficiently robust against false positives. Some clinical factors that may suggest malingering during the ADHD assessment are highlighted and some available tests to detect malingering are discussed.
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Cavaco AM, Ribeiro J, Nørgaard LS. Exploring the use of cognitive enhancement substances among Portuguese university students. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 5:100097. [PMID: 35478516 PMCID: PMC9032074 DOI: 10.1016/j.rcsop.2021.100097] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/09/2021] [Accepted: 12/09/2021] [Indexed: 11/25/2022] Open
Abstract
Background Prescription drug use and the consumption of substances to enhance college students' cognitive performance, described as pharmacological cognitive enhancement (PCE), is a known phenomenon potentially impacting individuals' health. University and college students are two specific subpopulations noted to use PCE (up to 17%, on average). To our knowledge, no data have been published on the use of PCE drugs among university students at a national level in Portugal and the factors that might be associated with this usage. Objective The main objective was to estimate the prevalence of PCE use by Portuguese university students and to identify the PCE substances commonly used by university students, i.e., those classified as prescription drugs and other legal and nonprescribed substances, including food supplements. Methods The study followed a cross-sectional exploratory, descriptive design and pursued a convenience sample of students from Portuguese public and private universities (22 higher education institutions). Results From a sample of 745 university students, 32% indicated the use of prescribed and nonprescribed substances. The most consumed substances were food supplements with CNS stimulants being the most frequent prescription-only drugs but not necessarily accessed through a medical prescription. A significant statistical association was found between substance consumption and the field of study. Health science students reported more food supplements and drug intake, allegedly under prescribed regimens, compared to humanities and exact sciences students. The study discusses the need to better understand the competitive societies that produce and support young students' outputs and the perceived ‘need’ for performance-enhancing substances. Conclusions One-third of the university students aimed to improve their performance by pharmacological cognitive enhancement, with a preference for food supplements dispensed in pharmacies. PCE substance consumption in higher education is thus non-negligible. The study suggests the need to improve regulations on potential inequalities in academic rankings and success and an observant attitude concerning implications that negatively affect health in the long run.
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Sabbe M, Sawchik J, Gräfe M, Wuillaume F, De Bruyn S, Van Antwerpen P, Van Hal G, Desseilles M, Hamdani J, Malonne H. Use and misuse of prescription stimulants by university students: a cross-sectional survey in the french-speaking community of Belgium, 2018. Arch Public Health 2022; 80:54. [PMID: 35168683 PMCID: PMC8848864 DOI: 10.1186/s13690-022-00816-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/05/2022] [Indexed: 12/05/2022] Open
Abstract
Background Misuse of prescription stimulants (PS) has been reported among students to enhance academic performance in Flanders (Belgium). However, PS misuse among students in the French-speaking community is unknown. The main purpose of the study was to estimate the prevalence of medical use and misuse of PS by university students in the French-speaking community (Belgium), and to investigate the reasons and sources associated with PS misuse. Methods A cross-sectional online survey was performed in 2018. All university students 18 years and older were invited to participate and asked about PS use, including medical (i.e., used for therapeutic purposes) and nonmedical reasons and sources of PS. Results In total, 12 144 students participated in the survey (median age = 21 years, 65.5% female). The estimated prevalence of PS use was 6.9% (ever use) and 5.5% (past-year). Among ever users, 34.7% were classified as medical users and 65.3% as misusers. Lifetime prevalence of misuse was estimated at 4.5%. The most common reason for medical use was treatment of attention disorder (85.9%). Reasons for misuse were mainly to improve concentration (76.1%) or to stay awake and study longer (50.7%). Friends or acquaintances inside the student community and general practitioners were the main sources of PS for misuse (41.5% and 23.5%, respectively). Conclusions This study found that rates of misuse of PS in French-speaking universities in Belgium were in line with studies conducted in Flanders and Europe. Academic institutions can use these results to tailor their drug prevention campaigns.
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Affiliation(s)
- Martine Sabbe
- Scientific Directorate of Epidemiology and public health - Sciensano, Brussels, Belgium. .,DG Post authorisation - Federal Agency for Medicines and Health Products, Brussels, Belgium.
| | - Javier Sawchik
- DG Post authorisation - Federal Agency for Medicines and Health Products, Brussels, Belgium
| | - Mégane Gräfe
- Unit of Pharmacology, Pharmacotherapy and Pharmaceutical Care, Faculty of Pharmacy, Université libre de Bruxelles, Brussels, Belgium
| | - Françoise Wuillaume
- DG Post authorisation - Federal Agency for Medicines and Health Products, Brussels, Belgium
| | - Sara De Bruyn
- Department of Sociology, University of Antwerp, Antwerp, Belgium
| | - Pierre Van Antwerpen
- RD3-Pharmacognosy, Bioanalysis and Drug Discovery- Faculty of Pharmacy, Université libre de Bruxelles, Brussels, Belgium
| | - Guido Van Hal
- Unit of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium
| | | | - Jamila Hamdani
- DG Post authorisation - Federal Agency for Medicines and Health Products, Brussels, Belgium
| | - Hugues Malonne
- DG Post authorisation - Federal Agency for Medicines and Health Products, Brussels, Belgium.,Unit of Pharmacology, Pharmacotherapy and Pharmaceutical Care, Faculty of Pharmacy, Université libre de Bruxelles, Brussels, Belgium.,Department of Biomedical Sciences, Namur Research Institute for Life Sciences, University of Namur, Namur, Belgium
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Al Rawwad T, Schrader PK, Brooks A, Duong L, Thornton D. Do nursing and pharmacy students practice what they preach on safe drug storage and disposal? A cross-sectional study. NURSE EDUCATION TODAY 2021; 107:105143. [PMID: 34583239 DOI: 10.1016/j.nedt.2021.105143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/25/2021] [Accepted: 09/07/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Research has confirmed a lack of knowledge regarding the risks of unused medications including diversion, misuse, or accidental overdose among health care professionals (Abdulmajeed, 2020). Nurses and pharmacists are often who patients interact with the most regarding medications; therefore, early education on proper storage and disposal is vital (Bowen, Rotz, Patterson, & Sen, 2017; Celio, Ninane, Bugnon, & Schneider, 2018). OBJECTIVES The study's objective is to explore safe drug storage and disposal knowledge, attitudes, and practices of professional pharmacy (Pharm.D.) and nursing students. DESIGN This research is an exploratory cross-sectional study from May to September 2019. METHODS An anonymous online survey was administered to a purposive sample of Pharm.D. and nursing students who were 18 years and older and enrolled in the site's accredited Pharm.D. and nursing programs (N = 210). Responses were analyzed using descriptive statistics. RESULTS Common disposal methods reported by students of their personal medications such as pills and liquids included discarding medications with the household trash (range 30% to 55%) and medication disposal products/bag (range 19% to 28%). More than half of the participants (50.4%) had unused prescription medication at home, 35% kept the medication for later use, and almost 20% of the participants reported sharing personal medications with others. CONCLUSION Although the majority of student participants had adequate knowledge of the appropriate methods for safe drug disposal, few reported using them for their own personal medications. The findings suggest there is a disconnect between the participants' knowledge of the appropriate methods of safe drug storage and disposal in a professional setting and their own practices. Further research is needed to explore and address the reasons for this disconnect. Additionally, findings from this research will assist in the development of and/or the improvement of interdisciplinary educational materials among pharmacy and nursing students.
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Affiliation(s)
- Tamara Al Rawwad
- School of Social Work, University of Texas Rio Grande Valley, 1201 W. University Drive, Edinburg, TX 78539, United States of America.
| | - Patrici K Schrader
- College of Nursing, University of Houston at Sugar Land, 14000 University Blvd., Sugar Land, TX 77479, United States of America.
| | - Andrea Brooks
- College of Nursing, University of Houston at Katy, 22400 Grand Cir. Room: 306H, Katy, TX 77449, United States of America.
| | - Lillian Duong
- University of Houston College of Pharmacy, United States of America.
| | - Douglas Thornton
- College of Pharmacy, University of Houston, Health 2 Building-Room 4055, Houston, TX 77204-5000, United States of America.
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Prescription Stimulant Misuse and Diversion Events Among College Students: A Qualitative Study. J Prim Prev 2021; 43:49-66. [PMID: 34729661 DOI: 10.1007/s10935-021-00654-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2021] [Indexed: 10/19/2022]
Abstract
Prescription stimulant misuse and diversion are interrelated behaviors: diversion increases the availability of stimulants for misuse, and persons who misuse are also more likely to divert. To date, research has examined these behaviors using a primarily quantitative lens. We led a qualitative investigation to better understand misuse and diversion events. Data are from a diverse southern California campus where we interviewed students who misuse and/or divert prescription stimulants (32 total interviews: 16 interviews with students who had a history of misuse, and 16 different interviews with students who had a history of diversion). We analyzed interview data inductively. We identified the following themes about misuse and diversion events, several of which intersected during interviews: medication surplus, diversion and misuse hubs, ease of behavior performance, academic stress, and other drugs commonly involved. For diversion, altruism and monetary gain were juxtaposed themes. Across themes, friends and family were influential figures. Implications for prevention, intervention, and future research directions are discussed.
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Sümbül-Şekerci B, Bildik Ö, Bektay MY, İzzettin FV. Attitudes of medicine, pharmacy, and dentistry students about psychostimulant use to enhance cognition. Int J Clin Pract 2021; 75:e14608. [PMID: 34231947 DOI: 10.1111/ijcp.14608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 06/28/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The use of psychostimulant drugs to increase academic success is common among young people. There is no study examining this issue in Turkish population. In this study, the prevalence, attitudes, knowledge, and ethical evaluations of Pharmacological Cognitive Enhancement (PCE) in university students were investigated. METHOD A structured online survey was carried out with 1148 undergraduate and postgraduate (master, PhD and residency) students in different faculties of Medicine, Dentistry and Pharmacy in Turkey. Comparisons between groups, correlation and regression analysis about associated variables were made. RESULTS The general prevalence of PCE in our study was found to be 7.4%. The highest prevalence was seen in the faculty of medicine (8.4%), among the residency students (15.5%). There was no significant difference prevalence of PCE between the faculties. Education level, smoking, study performance satisfaction, and knowledge level were found to be factors associated with PCE. Around 40% of PCE users stated that they used it with the recommendation of their friends. PCE users had a lower perception of harm and risk, and rated the use of it as more acceptable and normal behaviour. CONCLUSION PCE is a method used by young with high knowledge, low study performance satisfaction, to increase their academic success, especially during exam periods. Peer effect is an important factor in increasing prevalence.
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Affiliation(s)
- Betül Sümbül-Şekerci
- Department of Clinical Pharmacy, Faculty of Pharmacy, Bezmialem Vakif University, Istanbul, Turkey
| | - Özlem Bildik
- Department of History of Medicine and Ethics, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
- Graduate School of Health Sciences, Medical History and Ethics, Istanbul University, Istanbul, Turkey
| | - Muhammed Yunus Bektay
- Department of Clinical Pharmacy, Faculty of Pharmacy, Bezmialem Vakif University, Istanbul, Turkey
- Department of Clinical Pharmacy, Institute of Health Sciences, Marmara University, Istanbul, Turkey
| | - Fikret Vehbi İzzettin
- Department of Clinical Pharmacy, Faculty of Pharmacy, Bezmialem Vakif University, Istanbul, Turkey
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Vuolo M, Frizzell LC, Kelly BC. Trends in psychotropic-drug-implicated mortality: Psychotropic drugs as a contributing but non-underlying cause of death. Drug Alcohol Depend 2021; 226:108843. [PMID: 34218006 PMCID: PMC8355085 DOI: 10.1016/j.drugalcdep.2021.108843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/07/2021] [Accepted: 05/17/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Drug overdoses have contributed to considerable years of life lost. However, focusing solely on drug overdoses, whereby drug poisoning defines the underlying cause of death, obscures the wider burden of the drug mortality crisis. We aim to describe 21 years of trends in "psychotropic-drug-implicated deaths," those where psychotropic drugs are a contributing (but not the underlying) cause of death. METHODS We analyze deaths extracted from CDC WONDER from 1999-2019 to generate annual counts and rates for psychotropic-drug-implicated deaths in the United States, including by underlying cause of death and drug implicated. RESULTS Over 21 years, 51,446 psychotropic-drug-implicated deaths occurred (33,885 medical; 17,561 external). Both medical and external psychotropic-drug-implicated deaths rose dramatically, increasing 2.5 and 5.0 times, respectively. Diseases of the circulatory system predominated underlying causes of medical deaths (74 %). Non-drug suicide, transport accidents, and drownings constitute 54 % of external underlying causes. Among the various underlying causes of death, psychotropic-drug-implicated deaths represent a considerable proportion, especially among external causes, with the proportion greatly increasing over the observation period. The drug implicated evolves from cocaine to opioids to psychostimulants, with the latter rising considerably. CONCLUSIONS The drug mortality crisis extends beyond overdose and may temper improvements observed within other causes of mortality, such as cardiovascular disease, transport accidents, and drownings. As with overdoses, psychotropic-drug-implicated deaths have risen dramatically during the 21st century. They include striking increases for drugs, such as psychostimulants, receiving less attention with overdoses. Research is needed to address prevention, intervention, and policy for psychotropic-drug-implicated deaths beyond overdose mortality.
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Affiliation(s)
- Mike Vuolo
- Department of Sociology, The Ohio State University, 236 Townshend Hall, 1885 Neil Avenue Mall, Columbus, OH, 43201, USA
| | - Laura C Frizzell
- Department of Sociology, The Ohio State University, 236 Townshend Hall, 1885 Neil Avenue Mall, Columbus, OH, 43201, USA
| | - Brian C Kelly
- Department of Sociology, Purdue University, 700 W. State St, West Lafayette, IN, 47907, USA.
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Pharmacological Neuroenhancement: Current Aspects of Categorization, Epidemiology, Pharmacology, Drug Development, Ethics, and Future Perspectives. Neural Plast 2021; 2021:8823383. [PMID: 33519929 PMCID: PMC7817276 DOI: 10.1155/2021/8823383] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 12/15/2020] [Accepted: 12/30/2020] [Indexed: 11/17/2022] Open
Abstract
Recent pharmacoepidemiologic studies suggest that pharmacological neuroenhancement (pNE) and mood enhancement are globally expanding phenomena with distinctly different regional characteristics. Sociocultural and regulatory aspects, as well as health policies, play a central role in addition to medical care and prescription practices. The users mainly display self-involved motivations related to cognitive enhancement, emotional stability, and adaptivity. Natural stimulants, as well as drugs, represent substance abuse groups. The latter comprise purines, methylxanthines, phenylethylamines, modafinil, nootropics, antidepressants but also benzodiazepines, β-adrenoceptor antagonists, and cannabis. Predominant pharmacodynamic target structures of these substances are the noradrenergic/dopaminergic and cholinergic receptor/transporter systems. Further targets comprise adenosine, serotonin, and glutamate receptors. Meta-analyses of randomized-controlled studies in healthy individuals show no or very limited verifiability of positive effects of pNE on attention, vigilance, learning, and memory. Only some members of the substance abuse groups, i.e., phenylethylamines and modafinil, display positive effects on attention and vigilance that are comparable to caffeinated drinks. However, the development of new antidementia drugs will increase the availability and the potential abuse of pNE. Social education, restrictive regulatory measures, and consistent medical prescription practices are essential to restrict the phenomenon of neuroenhancement with its social, medical, and ethical implications. This review provides a comprehensive overview of the highly dynamic field of pharmacological neuroenhancement and elaborates the dramatic challenges for the medical, sociocultural, and ethical fundaments of society.
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Kogan SM, Bae D, Sigfusdottir ID, Kristjansson AL. Mental Health, Academic Engagement, and Youths' Nonmedical Use of Stimulants: A Latent Profile Analysis. Subst Use Misuse 2021; 56:479-483. [PMID: 33605832 DOI: 10.1080/10826084.2021.1879147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND: Nonmedical prescription stimulant (NPS) use is a growing problem in Europe. Poor mental health and lack of academic engagement are potent sources of risk for substance use. Studies suggest that considerable heterogeneity may characterize the risk profiles of NPS users. To understand better the potential profiles of risk that characterize NPS users, we conducted a latent profile analysis (LPA) to document subgroups of users based on their mental health and academic engagement. METHODS: A nationally representative, cross sectional survey of Icelandic youth was analyzed. The sample included 584 (5% of the sample) older adolescent students participating in a national study in Iceland who reported lifetime NPS use. RESULTS: Three subgroups of NPS users emerged from our analyses. The largest subgroup (43.1%) we labeled mentally healthy achievers; youth who appear to be academically motivated and have few if any mental health concerns. The second largest group (40.4%), low achievers, resembled a typical profile for drug users in that they reported low or modest academic engagement and moderate levels of mental health concerns. The third group, anxious achievers (16.5%) appears to represent youth who felt academics were very important, had moderate study motivation, and also reported elevated mental health concerns, especially anxiety. CONCLUSIONS: LPA revealed considerable heterogeneity among these users. Group membership suggests distinct approaches to prevention to address heterogeneity in motivations for NPS use.
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Affiliation(s)
- Steve M Kogan
- Human Development and Family Science, University of Georgia, Athens, USA
| | - Dayoung Bae
- Department of Home Economics Education, Korea University, Seongbuk-gu, Republic of Korea
| | - Inga Dora Sigfusdottir
- Icelandic Centre for Social Research and Analysis, Reykjavik University, Reykjavik, Iceland
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Soeiro T, Frauger É, Pradel V, Micallef J. Doctor shopping for methylphenidate as a proxy for misuse and potential abuse in the 67 million inhabitants in France. Fundam Clin Pharmacol 2020; 35:751-761. [PMID: 33025606 DOI: 10.1111/fcp.12612] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/02/2020] [Accepted: 10/01/2020] [Indexed: 01/15/2023]
Abstract
Doctor shopping enables subjects to receive more than the prescribed dose out of any medical management, which suggests a search for high doses and makes doctor shopping a relevant proxy for misuse and potential abuse. Therefore, this study aimed to identify and characterize profiles of subjects with doctor-shopping behavior for methylphenidate in the entire French population. This study is a cross-sectional study of doctor-shopping behavior for methylphenidate in France, in 2016, using the Système national des données de santé, and accounting for overlapping prescriptions. Subjects who obtained >840 mg by doctor shopping were defined as subjects with heavy doctor-shopping behavior, and subjects who obtained >0 mg and ≤840 mg by doctor shopping were defined as subjects with light doctor-shopping behavior. A total of 63 739 subjects were included, and received 339.6 kg of methylphenidate. Among them, 216 (0.3%) subjects had heavy doctor-shopping behavior, and 313 (0.5%) subjects had light doctor-shopping behavior. Compared with subjects with light doctor-shopping behavior, subjects with heavy doctor-shopping behavior were older (64% of 30- to 49-year-old subjects vs. 77% of ≤17-year-old subjects; P < 0.001), received more concomitant dispensings of antipsychotics (37% vs. 26%; P = 0.008) and opioid maintenance treatments (50% vs. 6%; P < 0.001), and had more prescribers (4 [IQR = 2-5] vs. 2 [IQR = 2-3]; P < 0.001). In the French context where prescription and dispensing of methylphenidate are highly regulated and methylphenidate is much less used than in other countries, these results are a warning signal to avoid trivializing methylphenidate in adults.
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Affiliation(s)
- Thomas Soeiro
- Aix-Marseille Université, Inserm, UMR 1106, Assistance publique - Hôpitaux de Marseille, Service de Pharmacologie Clinique, Centre d'Évaluation et d'Information sur la Pharmacodépendance - Addictovigilance, 264 rue Saint Pierre, Marseille, 13005, France
| | - Élisabeth Frauger
- Aix-Marseille Université, Inserm, UMR 1106, Assistance publique - Hôpitaux de Marseille, Service de Pharmacologie Clinique, Centre d'Évaluation et d'Information sur la Pharmacodépendance - Addictovigilance, 264 rue Saint Pierre, Marseille, 13005, France
| | - Vincent Pradel
- Aix-Marseille Université, Inserm, UMR 1106, Assistance publique - Hôpitaux de Marseille, Service de Pharmacologie Clinique, Centre d'Évaluation et d'Information sur la Pharmacodépendance - Addictovigilance, 264 rue Saint Pierre, Marseille, 13005, France
| | - Joëlle Micallef
- Aix-Marseille Université, Inserm, UMR 1106, Assistance publique - Hôpitaux de Marseille, Service de Pharmacologie Clinique, Centre d'Évaluation et d'Information sur la Pharmacodépendance - Addictovigilance, 264 rue Saint Pierre, Marseille, 13005, France
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15
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Lam C, Figueroa W, Yomogida K, Bavarian N. Prescription stimulant diversion on a college campus: Intrapersonal, interpersonal and environmental correlates. JOURNAL OF DRUG ISSUES 2020; 50:329-340. [PMID: 34305170 DOI: 10.1177/0022042620917103] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Prescription stimulant diversion is a behavior that increases the availability and accessibility of prescription stimulants for purposes such as misuse. As such, we aimed to develop a theory-guided understanding of diversion correlates. Methods Data are from a probability sample of 499 undergraduate college students attending one California university. Participants completed a 100-item survey related to prescription stimulant misuse and diversion. We first calculated prevalence of diversion and associations with demographic variables. Next, to examine intrapersonal, interpersonal and environmental correlates of diversion, we estimated three separate nested logistic regression models. Results Prescription stimulant diversion was reported by approximately 10% of the sample. In the nested logistic analyses, diversion was found to be associated with intrapersonal, interpersonal and environmental variables. Conclusions These findings highlight the importance of examining a comprehensive set of correlates to identify subgroups of students at risk for engaging in sharing and/or selling of prescription stimulants.
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Affiliation(s)
- Cammie Lam
- California State University, Long Beach, 1250 Bellflower Blvd, Long Beach, CA 90840
| | - Wilma Figueroa
- California State University, Long Beach, 1250 Bellflower Blvd, Long Beach, CA 90840
| | - Kyle Yomogida
- California State University, Long Beach, 1250 Bellflower Blvd, Long Beach, CA 90840
| | - Niloofar Bavarian
- Health Science Department, California State University Long, Beach, 1250 Bellflower Blvd, Long Beach, CA 90840
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16
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Woźniak-Karczewska M, Baranowski D, Framski G, Marczak Ł, Čvančarová M, Corvini PFX, Chrzanowski Ł. Biodegradation of ritalinic acid by Nocardioides sp. - Novel imidazole-based alkaloid metabolite as a potential marker in sewage epidemiology. JOURNAL OF HAZARDOUS MATERIALS 2020; 385:121554. [PMID: 31753665 DOI: 10.1016/j.jhazmat.2019.121554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 10/12/2019] [Accepted: 10/25/2019] [Indexed: 06/10/2023]
Abstract
The consumption of methylphenidate, a nootropic drug used to improve mental performance, is becoming increasingly serious. Methylphenidate is metabolized in human liver to ritalinic acid, which has been commonly detected in sewage and surface waters. Additionally, ritalinic acid serves as a biomarker in sewage epidemiology studies. Thus knowledge of the stability and microbial degradation pathways of ritalinic acid is essential for proper estimation of methylphenidate consumption. In the study reported here, we describe the fast formation of a previously unknown, dead-end metabolite of ritalinic acid by Nocardioides sp. strain MW5. HRMS and 2D NMR analyses allowed precisely identification of the compound as an imidazole-based alkaloid cation with chemical formula 11-[3-(formylamino)propyl]-1,2,3,4,6,7,8,9-octahydrodipyrido[1,2-a:1',2'-c]imidazole-5-ium. In experiments, Nocardioides sp. strain MW5 transformed 34% of ritalinic acid into this metabolite, while 52% was mineralized into CO2. Alkaloid was not biodegraded during the OECD 301 F test. This study provides new insight into the environmental fate of methylphenidate and its metabolites. The data collected are essential for assessing nootropic drug consumption by sewage epidemiology and should lead to a better understanding of microbial degradation of ritalinic acid.
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Affiliation(s)
- Marta Woźniak-Karczewska
- Institute of Chemical Technology and Engineering, Poznan University of Technology, Berdychowo 4, 60-965 Poznan, Poland; Institute for Ecopreneurship, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland, Gründenstrasse 40, 4132 Muttenz, Switzerland.
| | - Daniel Baranowski
- Institute of Bioorganic Chemistry, Polish Academy of Sciences, Noskowskiego 12/14, 61-704 Poznań, Poland
| | - Grzegorz Framski
- Institute of Bioorganic Chemistry, Polish Academy of Sciences, Noskowskiego 12/14, 61-704 Poznań, Poland
| | - Łukasz Marczak
- Institute of Bioorganic Chemistry, Polish Academy of Sciences, Noskowskiego 12/14, 61-704 Poznań, Poland
| | - Monika Čvančarová
- Institute for Ecopreneurship, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland, Gründenstrasse 40, 4132 Muttenz, Switzerland
| | - Philippe F-X Corvini
- Institute for Ecopreneurship, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland, Gründenstrasse 40, 4132 Muttenz, Switzerland; State Key Laboratory for Pollution Control and Resource Reuse, School of the Environment, Nanjing University, Nanjing 210093, PR China
| | - Łukasz Chrzanowski
- Institute of Chemical Technology and Engineering, Poznan University of Technology, Berdychowo 4, 60-965 Poznan, Poland
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17
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Gudmundsdottir BG, Weyandt L, Ernudottir GB. Prescription Stimulant Misuse and ADHD Symptomatology Among College Students in Iceland. J Atten Disord 2020; 24:384-401. [PMID: 28013572 DOI: 10.1177/1087054716684379] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective: Misuse of prescription stimulant medication is a prevalent problem on American college campuses; however, few studies have been conducted beyond the United States. Although Iceland has the highest methylphenidate prescription rates in the world, prevalence of stimulant misuse within the Icelandic college student population remains to be investigated. Method: We examined the prevalence of prescription stimulant misuse among N = 521 college students in Iceland, using an online survey. Results: Overall prevalence of lifetime stimulant misuse was approximately 13%; 11% among participants without a prescription for stimulant medication, and 42% among participants holding a prescription. The primary reported reason for misuse was academic enhancement; risk factors included male sex, anxiety symptoms, and ADHD symptomatology. Conclusion: The present findings have implications for public health policy in Iceland, particularly as it relates to the college population. Prevention and intervention programs that provide college students with safer strategies to manage academic demands are warranted.
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18
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Vosburg SK, Robbins RS, Antshel KM, Faraone SV, Green JL. Characterizing Pathways of Non-oral Prescription Stimulant Non-medical Use Among Adults Recruited From Reddit. Front Psychiatry 2020; 11:631792. [PMID: 33597899 PMCID: PMC7883730 DOI: 10.3389/fpsyt.2020.631792] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 12/16/2020] [Indexed: 01/17/2023] Open
Abstract
Objective: Prescription stimulant non-medical use (NMU) is a national predicament. While the risks of prescription stimulant NMU have been considered, less is known about non-oral use. To focus on this gap, a sample of adults with non-oral prescription stimulant NMU within the last 5-years was recruited. The purpose of the present study was to characterize the pathways and substance transitions associated with prescription stimulant NMU and non-oral prescription stimulant NMU in this unique sample of adults. Methods: Adults (n = 225) reporting non-oral prescription stimulant NMU within the last 5 years were recruited to complete an online survey by banner ads placed on the Reddit website between February and September 2019. After completion of the survey, a second study consisting of an in-depth telephone interview was conducted with 23 participants: interviews took place between July and September 2019. Data reported here include substance, route of administration and class transitions, as well as qualitative data from the interviews. Results: Approximately 1 in 5 began their substance use trajectory with prescription stimulants (19.1%). Other than marijuana, most exposures to illicit substances occurred after both initial prescription stimulant NMU and initial non-oral prescription stimulant NMU. The most frequently reported route of administration transition was from oral use to snorting (n = 158, 70.2%), however, other route of administration transitions included oral use to injection drug use (n = 14, 6%). In-depth interviews elaborated upon these transitions and indicated that prescription stimulant NMU was consequential to substance use pathways. Conclusions: Oral prescription stimulant NMU was a precursor to non-oral prescription stimulant NMU. Non-oral prescription stimulant NMU was a precursor to illicit substance use, suggesting that prescription stimulant NMU impacts substance use pathways and revealing opportunities for intervention.
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Affiliation(s)
| | | | - Kevin M Antshel
- Department of Psychology, Syracuse University, Syracuse, NY, United States
| | - Stephen V Faraone
- Department of Psychiatry, State University of New York (SUNY) Upstate Medical University, Syracuse, NY, United States
| | - Jody L Green
- Inflexxion, An IBH Company, Costa Mesa, CA, United States
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19
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Goodhines PA, Taylor LE, Zaso MJ, Antshel KM, Park A. Prescription Stimulant Misuse and Risk Correlates among Racially-Diverse Urban Adolescents. Subst Use Misuse 2020; 55:2258-2267. [PMID: 32749179 PMCID: PMC7665830 DOI: 10.1080/10826084.2020.1800740] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Most research on prescription stimulant misuse has focused on college students, and research on high school-aged adolescents is limited. OBJECTIVES This study aimed to characterize risk correlates of prescription stimulant misuse among a racially-diverse and socioeconomically-disadvantaged sample of urban adolescents. METHOD Cross-sectional data were drawn from an ongoing study of adolescent health behaviors, Project Teen. Participants were 414 9th to 11th graders (Mage=16.00 [SD = 1.08]; 57% female; 41% Black or African American, 22% White, 18% Asian, 17% Multiracial, 2% Pacific Islander, and 1% Native American; 12% Hispanic/Latinx). Participants completed a web-based survey assessing prescription stimulant misuse, demographics, mental health and personality, social environment, and substance use. RESULTS Eight percent of participants endorsed past-year prescription stimulant misuse. Compared to non-misusing peers, participants endorsing past-year prescription stimulant misuse reported greater depression/anxiety symptoms, sensation seeking, perceived peer risk behavior, and alcohol and cigarette use, as well as a lower level of parental monitoring; null group differences were observed for academic goal orientation, perceived peer approval of risk behavior, and cannabis use. Binary logistic regression demonstrated that binge drinking and cigarette use were significantly associated with prescription stimulant misuse over and above all other identified risk variables. CONCLUSIONS Adolescent prescription stimulant misuse appears to overlap with general adolescent substance use, sharing several known risk correlates. Results highlight potential targets for identification of emerging prescription stimulant misuse risk profiles at earlier stages of development. Longitudinal replication is needed to examine directional associations and risk mechanisms underlying adolescent prescription stimulant misuse.
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Affiliation(s)
| | - Lea E Taylor
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Michelle J Zaso
- Clinical and Research Institute on Addictions, University at Buffalo, Buffalo, New York, USA
| | - Kevin M Antshel
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Aesoon Park
- Department of Psychology, Syracuse University, Syracuse, New York, USA
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20
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Brandt L, Fischer G. Adult ADHD Is Associated With Gambling Severity and Psychiatric Comorbidity Among Treatment-Seeking Problem Gamblers. J Atten Disord 2019; 23:1383-1395. [PMID: 28162086 DOI: 10.1177/1087054717690232] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective: The aim of this study is as follows: (a) exploring retrospective childhood and adult ADHD symptomatology in treatment-seeking gamblers, (b) providing detailed characteristics of the association between pathological gambling (PG) and ADHD, and (c) identifying risk factors for a history of ADHD. Method: Eighty problem gamblers (20% female) were examined using a standardized interview (PG: Diagnostic and Statistical Manual of Mental Disorders [4th ed.; DSM-IV] criteria, Gambling Attitudes and Beliefs Survey; ADHD: Wender Utah Rating Scale-deutsche Kurzform, Adult ADHD Self-Report Scale; comorbidities: Mini International Neuropsychiatric Interview). Results: Forty-three percentage of patients screened positive for childhood ADHD, and in 11%, ADHD persisted in adulthood. Patients with adult ADHD had more severe gambling problems (p = .009, d = 1.03) and a higher number of psychiatric comorbidities (p < .001, d = 1.62) compared with those without ADHD. Substance abuse/dependence constituted a predictor for having a history of ADHD (odds ratio [OR] = 4.07, p = .025). Conclusion: ADHD-PG comorbidity is linked to factors that worsen the prognosis. Thus, screening for ADHD and verifying persistence in adulthood should be an integral component in the interdisciplinary treatment of problem/pathological gamblers.
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Affiliation(s)
- Laura Brandt
- 1 University of Vienna, Austria.,2 Medical University of Vienna, Austria
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21
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Wilms W, Woźniak-Karczewska M, Corvini PFX, Chrzanowski Ł. Nootropic drugs: Methylphenidate, modafinil and piracetam - Population use trends, occurrence in the environment, ecotoxicity and removal methods - A review. CHEMOSPHERE 2019; 233:771-785. [PMID: 31200137 DOI: 10.1016/j.chemosphere.2019.06.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/28/2019] [Accepted: 06/02/2019] [Indexed: 06/09/2023]
Abstract
Pharmaceuticals which originally were designed to treat people with neurological and psychiatric conditions, e.g. Alzheimer's disease or attention deficit hyperactivity disorder (ADHD), are nowadays often misused by students as a 'brain doping' substances. These substances are known as nootropic drugs, smart drugs or cognitive enhancers, as they increase memory, attention and concentration of healthy individuals. Since they are easily available illicitly, their consumption is observed to be growing. Currently, these pharmaceuticals started gaining researchers' attention, especially since they have been recently detected in wastewater, surface water and even drinking water. This review summarises the current state of knowledge on nootropic drugs in terms of their population use trends and ethics, occurrence in the environment and detection techniques, toxicity and removal methods, in example of methylphenidate, modafinil and piracetam - three most popular nootropics. It points out that the main sources of knowledge on cognitive enhancers illicit use are often inconsistent questionnaires, which are not supported by wastewater analysis to become more veracious. Simultaneously, the studies concerning toxicity and removal methods of nootropic drugs are still limited and in many cases environmentally irrelevant. Although the prescription rules has been subjected to more strict control in developed countries, regulatory frameworks with regard to their ecosystem occurrence are still lacking and should be introduced. Moreover, the use of environmentally relevant concentrations in toxicity studies should be a standard, leading to proper ecotoxicity risk assessment. Based on this review, it is recommended to routinely monitor nootropics and their metabolites in waste- and surface waters.
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Affiliation(s)
- Wiktoria Wilms
- Faculty of Chemical Technology, Poznan University of Technology, Berdychowo 4, 60-965, Poznań, Poland
| | - Marta Woźniak-Karczewska
- Faculty of Chemical Technology, Poznan University of Technology, Berdychowo 4, 60-965, Poznań, Poland
| | - Philippe F-X Corvini
- Institute for Ecopreneurship, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland, Gründenstrasse 40, 4132, Muttenz, Switzerland
| | - Łukasz Chrzanowski
- Faculty of Chemical Technology, Poznan University of Technology, Berdychowo 4, 60-965, Poznań, Poland.
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22
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De Bruyn S, Wouters E, Ponnet K, Van Hal G. Popping smart pills in medical school: Are competition and stress associated with the misuse of prescription stimulants among students? Subst Use Misuse 2019; 54:1191-1202. [PMID: 30892122 DOI: 10.1080/10826084.2019.1572190] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND There has been increasing attention in both popular and scientific circles to the misuse of prescription stimulants by students. However, it is unclear which student groups are most vulnerable and what environmental factors could influence this misuse. Medical students might be more at risk because of high levels of competition and related stress in medical school, making them a relevant population to explore these interrelationships. OBJECTIVES This study aims to answer two research questions: (1) Does competition lead to higher stress and greater likelihood of misuse? and (2) Do the levels of and interrelationships between competition, stress and misuse vary between students with different post-graduate aspirations? METHODS In total, 3159 Flemish medical students (48.99% response rate) participated anonymously in a 2016 questionnaire on stimulants. Misuse was defined as use to enhance study performance, but not as part of an applicable treatment. We performed (multiple group) structural equation modeling to answer the research questions. RESULTS Results indicate significant associations between competition, stress and misuse: the higher the perception of medical school as being competitive, the higher the stress level and the more likely the misuse. Against our expectations, the association between competition and stress was significantly stronger for future general practitioners (GPs) compared to future specialists. CONCLUSION The competitive climate in medical school creates high stress levels, rendering students vulnerable to misuse of stimulants. Students need to be educated about how to cope with stress in a non-pharmaceutical way, making them more resilient to stress during studentship and in their future careers.
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Affiliation(s)
- Sara De Bruyn
- a Department of Sociology , University of Antwerp , Antwerp , Belgium
| | - Edwin Wouters
- a Department of Sociology , University of Antwerp , Antwerp , Belgium
| | - Koen Ponnet
- b Department of Communication Sciences , IMEC-MICT-Ghent University , Ghent , Belgium
| | - Guido Van Hal
- c Department of Epidemiology and Social Medicine, Social Epidemiology and Health Policy , University of Antwerp , Antwerp , Belgium
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Thiel AM, Kilwein TM, De Young KP, Looby A. Differentiating motives for nonmedical prescription stimulant use by personality characteristics. Addict Behav 2019; 88:187-193. [PMID: 30223236 DOI: 10.1016/j.addbeh.2018.08.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/07/2018] [Accepted: 08/31/2018] [Indexed: 10/28/2022]
Abstract
Nonmedical prescription stimulant use (NPS) is increasing, particularly among college students. College students typically engage in NPS for cognitive enhancement, recreational, and appetite/weight-related purposes; however, little research has used these motives to identify specific risk for, or consequences of, NPS. Moreover, there may be unique risk factors for motive-specific NPS that have yet to be explored, such as relevant personality traits (i.e., distress tolerance, impulsivity, and perfectionism) that are associated with NPS in general. Therefore, this study aimed to examine whether NPS users and nonusers could be differentiated via facets of impulsivity, perfectionism, and distress tolerance, and whether users could be further differentiated by reported motive for use based on these traits. Midwestern university undergraduate students (N = 668) who were enrolled in a psychology research pool completed an online survey assessing demographics, NPS and motives, and measures of distress tolerance, impulsivity, and perfectionism. Participants were primarily female (78%) and aged 18-54 (M = 20.10, SD = 3.19) years. Univariate and multivariate analysis of variance tests revealed associations between lifetime NPS and higher impulsivity, higher perfectionism, and lower distress tolerance. Further tests revealed NPS for appetite/weight-related purposes was associated with lower distress tolerance, while NPS for recreational purposes was associated with higher impulsivity. These findings contribute novel information regarding NPS motives and personality constructs. This information may aid in comprehensive identification of high-risk individuals for NPS and inform the development of specialized prevention and intervention efforts.
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Hachtel JC, Armstrong KJ. Illicit Use of Prescription Stimulants: Gender Differences in Perceptions of Risk. Subst Use Misuse 2019; 54:1654-1662. [PMID: 31062635 DOI: 10.1080/10826084.2019.1608246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Little research exists on gender differences regarding the relationship between illicit use of prescription stimulants (IUPS) and perceptions of risk of illicit use. Risk perception is a common target for both prevention and intervention programs. Objectives: To measure gender differences in prevalence rates of illicit use and perceptions of legal, health, and social risks of illicit use. Method: Data from undergraduate students at a large, southeastern university (N = 1,714) were examined for gender differences in prevalence of illicit use and related risk perceptions. Results: More men engaged in illicit use than women (26.2% vs. 18.7%). Overall, men perceived lower legal, health, and social risks related to illicit use. Further, illicit users also perceived lower legal, health, and social risks. Nonusing men perceived lower legal and health risks than nonusing women, but similar levels of social risks. Within the subgroup of illicit users, men perceived lower health risks than women, but similar levels of legal and social risk. Conclusions/Importance: There were significant gender differences in IUPS and risk perception, with particular importance of lack of social risk perceived for all groups and lower health risk perception for men who had engaged in IUPS. It is unclear if the lower risk perceptions are present prior to or after illicit use begins and whether risk perceptions affect the development, maintenance, or termination of illicit use behaviors. Future research is needed to clarify these relationships and to evaluate whether increasing risk perceptions is a viable target for prevention or intervention efforts.
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Affiliation(s)
- Joanna C Hachtel
- a Mississippi State University , Mississippi State , Mississippi , USA
| | - Kevin J Armstrong
- a Mississippi State University , Mississippi State , Mississippi , USA
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25
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Lucke J, Jensen C, Dunn M, Chan G, Forlini C, Kaye S, Partridge B, Farrell M, Racine E, Hall W. Non-medical prescription stimulant use to improve academic performance among Australian university students: prevalence and correlates of use. BMC Public Health 2018; 18:1270. [PMID: 30453936 PMCID: PMC6245847 DOI: 10.1186/s12889-018-6212-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Some university students consume pharmaceutical stimulants without a medical prescription with the goal of improving their academic performance. The prevalence of this practice has been well documented in the US, but less so in other countries. The potential harms of using prescription stimulants require a better understanding of the prevalence of this practice within Australian universities. METHODS An internet survey of 1136 Australian students was conducted in 2015 in three large Australian universities. Students were asked about their personal use of prescription stimulants, attitudes and experiences with prescription stimulants. They were also asked about their use of caffeine, energy drinks and illicit drugs to enhance their academic performance. RESULTS Lifetime self-reported use of stimulant medication to improve academic performance was 6.5, and 4.4% in the past year. Students were far more likely to report using coffee and energy drinks (41.4 and 23.6% respectively, lifetime use) than prescription stimulants to help them study and complete university assessments. Non-medical use of prescription stimulants was strongly associated with a history of illicit drug use. CONCLUSION The prevalence of nonmedical prescription stimulant use to improve academic performance is low among university students in Australia, especially when compared with their use of coffee and energy drinks.
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Affiliation(s)
- Jayne Lucke
- Australian Research Centre in Sex, Health and Society, School of Psychology and Public Health, College of Science, Health and Engineering, Building NR6, La Trobe University, Bundoora, VIC, 3086, Australia. .,School of Public Health, The University of Queensland, Herston, Brisbane, QLD, Australia.
| | - Charmaine Jensen
- The University of Queensland Centre for Youth Substance Abuse Research, St Lucia, Brisbane, QLD, Australia
| | - Matthew Dunn
- School of Health and Social Development, Deakin University, Geelong, Australia.,National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Gary Chan
- The University of Queensland Centre for Youth Substance Abuse Research, St Lucia, Brisbane, QLD, Australia
| | - Cynthia Forlini
- Sydney Health Ethics, University of Sydney, Sydney, NSW, Australia
| | - Sharlene Kaye
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Bradley Partridge
- Research Development Unit, Caboolture Hospital, Caboolture, QLD, Australia.,School of Clinical Medicine, Prince Charles Hospital Northside Clinical Unit, The University of Queensland, Brisbane, QLD, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - Eric Racine
- Pragmatic Health Ethics Research Unit, Institut de recherches cliniques de Montréal, Montréal, Quebec, Canada
| | - Wayne Hall
- The University of Queensland Centre for Youth Substance Abuse Research, St Lucia, Brisbane, QLD, Australia
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26
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Compton WM, Han B, Blanco C, Johnson K, Jones CM. Prevalence and Correlates of Prescription Stimulant Use, Misuse, Use Disorders, and Motivations for Misuse Among Adults in the United States. Am J Psychiatry 2018; 175:741-755. [PMID: 29656665 PMCID: PMC6070393 DOI: 10.1176/appi.ajp.2018.17091048] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors sought to simultaneously examine the prevalence and correlates of prescription stimulant use, misuse, use disorders, and motivations for misuse in the U.S. adult population. METHOD This was a nationally representative household population study of adults age 18 or older from the 2015 and 2016 National Surveys on Drug Use and Health (N=102,000). Measurements included prescription stimulant use, use without misuse, misuse without use disorders, and misuse with use disorders, as well as sociodemographic characteristics, health conditions, and mental health factors. RESULTS Among U.S. adults, 6.6% (annual average) used prescription stimulants overall; 4.5% used without misuse, 1.9% misused without use disorders, and 0.2% had use disorders. Adults with past-year prescription stimulant use disorders did not differ from those with misuse without use disorders in any of the examined sociodemographic characteristics and in many of the examined substance use problems. The most commonly reported motivations for misuse were to help be alert or concentrate (56.3%). The most likely source of misused prescription stimulants was by obtaining them free from friends or relatives (56.9%). More frequent prescription stimulant misuse and use disorder were associated with an increased likelihood of obtaining medications from physicians or from drug dealers or strangers and less likelihood of obtaining them from friends or relatives. CONCLUSIONS Approximately 16.0 million U.S. adults used prescription stimulants in the preceding year (annual average), 5.0 million misused prescription stimulants, and 0.4 million had use disorders. Cognitive enhancement was the most commonly reported reason for misusing prescription stimulants. Patients who are using their medication for cognitive enhancement or diverting their medication to others present a high risk.
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Affiliation(s)
- Wilson M Compton
- From the National Institute on Drug Abuse, Bethesda, Md.; and the Substance Abuse and Mental Health Services Administration, Rockville, Md
| | - Beth Han
- From the National Institute on Drug Abuse, Bethesda, Md.; and the Substance Abuse and Mental Health Services Administration, Rockville, Md
| | - Carlos Blanco
- From the National Institute on Drug Abuse, Bethesda, Md.; and the Substance Abuse and Mental Health Services Administration, Rockville, Md
| | - Kimberly Johnson
- From the National Institute on Drug Abuse, Bethesda, Md.; and the Substance Abuse and Mental Health Services Administration, Rockville, Md
| | - Christopher M Jones
- From the National Institute on Drug Abuse, Bethesda, Md.; and the Substance Abuse and Mental Health Services Administration, Rockville, Md
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Maier LJ, Ferris JA, Winstock AR. Pharmacological cognitive enhancement among non-ADHD individuals—A cross-sectional study in 15 countries. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 58:104-112. [DOI: 10.1016/j.drugpo.2018.05.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 04/17/2018] [Accepted: 05/18/2018] [Indexed: 12/25/2022]
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Hulme S, Bright D, Nielsen S. The source and diversion of pharmaceutical drugs for non-medical use: A systematic review and meta-analysis. Drug Alcohol Depend 2018; 186:242-256. [PMID: 29626777 DOI: 10.1016/j.drugalcdep.2018.02.010] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 02/18/2018] [Accepted: 02/20/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The non-medical use (NMU) of pharmaceutical drugs is an increasing public health concern. This systematic review consolidates current knowledge about how pharmaceutical drugs are obtained for NMU and the processes and people involved in diversion. METHODS Peer-reviewed and grey literature databases were searched for empirical studies published between 1996 and 2017 that examined the source or diversion of pharmaceutical opioids, sedatives or stimulants for NMU in countries with reported misuse problems. Pooled prevalence meta-analyses using random effects models were used to estimate the prevalence of medical and non-medical sourcing reported by end-users, and gifting, selling and trading by various populations. RESULTS This review synthesizes the findings of 54 cross-sectional studies via meta-analyses, with a remaining 95 studies examined through narrative review. Pharmaceutical drugs are primarily sourced for NMU from friends and family (57%, 95% CI 53%-62%, I2 = 98.5, n = 30) and despite perceptions of healthcare professionals to the contrary, illegitimate practices such as doctor shopping are uncommon (7%, 95% CI 6%-10%, I2 = 97.4, n = 29). Those at risk of diversion include patients displaying aberrant medication behaviors, people with substance use issues and students in fraternity/sorority environments. Sourcing via dealers is also common (32%, 95% CI 23%-41%, I2 = 99.8, n = 25) and particularly so among people who use illicit drugs (47%, 95% CI 35%-60%, I2 = 99.1, n = 15). There is little to no organized criminal involvement in the pharmaceutical black market. CONCLUSION Pharmaceutical drugs for NMU are primarily sourced by end-users through social networks. Future research should examine how dealers source pharmaceutical drugs.
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Affiliation(s)
- Shann Hulme
- National Drug and Alcohol Research Centre, 22-32 King St, Randwick, NSW, 2031, Australia.
| | - David Bright
- School of Social Sciences, UNSW Australia, High Street, Kensington, NSW, 2052, Australia
| | - Suzanne Nielsen
- National Drug and Alcohol Research Centre, 22-32 King St, Randwick, NSW, 2031, Australia
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Abstract
OBJECTIVE To estimate the prevalence of adult ADHD diagnosis and treatment in U.S. Medicaid beneficiaries. METHOD Using outpatient, inpatient, and pharmacy billing records for patients eligible for Medicaid fee-for-service benefits within 29 states from 1999 to 2010, we estimated the annual prevalence of ADHD diagnosis and treatment. RESULTS The prevalence of ADHD diagnosis increased from 2.20 per 1,000 patients in 1999 to 10.57 in 2010. Likewise, prevalence of ADHD treatment increased from 1.95 per 1,000 patients in 1999 to 13.16 in 2010. Between 40% and 65%, patients had ADHD drug prescription fills 6 months after ADHD diagnosis, whereas 45% to 55% of the beneficiaries with an ADHD drug prescription fill had ADHD diagnoses within 6 months before the prescription. CONCLUSION In publicly insured adults, the prevalence of ADHD diagnosis and treatment increased dramatically over the years. Approximately half of the diagnosed patients are not treated, whereas half of the treated adults are not diagnosed.
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Affiliation(s)
- Yanmin Zhu
- 1 University of Florida, Gainesville, USA
| | - Wei Liu
- 2 Food and Drug Administration, Silver Spring, MD, USA
| | - Yan Li
- 1 University of Florida, Gainesville, USA
| | - Xi Wang
- 1 University of Florida, Gainesville, USA
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Ehrhardt C, Boucherie Q, Pauly V, Braunstein D, Ronflé E, Thirion X, Frauger E, Micallef J. Methylphenidate: Gender trends in adult and pediatric populations over a 7 year period. Therapie 2017; 72:635-641. [DOI: 10.1016/j.therap.2017.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/19/2017] [Accepted: 05/23/2017] [Indexed: 01/11/2023]
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Skoglund C, Brandt L, D'Onofrio B, Larsson H, Franck J. Methylphenidate doses in Attention Deficit/Hyperactivity Disorder and comorbid substance use disorders. Eur Neuropsychopharmacol 2017; 27:1144-1152. [PMID: 28935267 DOI: 10.1016/j.euroneuro.2017.08.435] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 07/15/2017] [Accepted: 08/30/2017] [Indexed: 01/07/2023]
Abstract
Patients with Attention Deficit/Hyperactivity Disorder (ADHD) and comorbid Substance Use Disorders (SUD) are increasingly being treated with central stimulant medication despite limited evidence for its effectiveness. Lack of longitudinal follow-up studies of dosing and adverse effects has resulted in conflicting treatment guidelines. This study aims to explore whether individuals with ADHD and comorbid SUD are treated with higher stimulant doses than individuals with ADHD only, and whether doses increase over time as a sign of tolerance, a core symptom of addiction. Information on methylphenidate doses for 14 314 Swedish adults, including 4870 individuals with comorbid SUD was obtained through linkages of Swedish national registers between 2006 and 2009. Differences in doses between patients with and without SUD were estimated using logistic regression while a linear regression model calculated time trends in mean doses. Individuals with SUD were prescribed higher methylphenidate doses than those without (ORday365; 2.12, 95% CI 1.81-2.47: ORday730 2.65, 95% CI 2.13-3.30). Patients with SUD were, two years after initiating stimulant treatment, prescribed approximately 40% higher doses compared to individuals with ADHD only. The results may suggest a need for increased doses in this population to achieve optimal ADHD symptom control. A tendency towards increasing doses during the first years of treatment, more pronounced in individuals with comorbid SUD, may reflect a reluctance to prescribe adequate doses due to lack of clinical guidelines. Mean doses stabilized after about two years in both groups, which does not lend support to continuously increasing tolerance over time.
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Affiliation(s)
- Charlotte Skoglund
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Norra Stationsgatan 69, SE-113 64 Stockholm, Sweden.
| | - Lena Brandt
- Center for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Department of Medicine, Solna, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Brian D'Onofrio
- Department of Psychological and Brain Sciences Indiana University, 1101 East 10th Street, Bloomington, IN 47405, USA
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, SE-171 77 Stockholm, Sweden
| | - Johan Franck
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Norra Stationsgatan 69, SE-113 64 Stockholm, Sweden
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Bjarnadottir GD, Johannsson M, Magnusson A, Rafnar BO, Sigurdsson E, Steingrimsson S, Asgrimsson V, Snorradottir I, Bragadottir H, Haraldsson HM. Methylphenidate disintegration from oral formulations for intravenous use by experienced substance users. Drug Alcohol Depend 2017. [PMID: 28651152 DOI: 10.1016/j.drugalcdep.2017.04.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Methylphenidate (MPH) is a prescription stimulant used to treat attention-deficit hyperactivity disorder. MPH is currently the preferred substance among most intravenous (i.v.) substance users in Iceland. Four types of MPH preparations were available in Iceland at the time of study: Immediate-release (IR), sustained-release (SR), osmotic controlled-release oral delivery (OROS) tablet and osmotic-controlled release (OCR). MPH OROS has previously been rated the least desirable by i.v. users and we hypothesized that this was associated with difficulty of disintegrating MPH from OROS formulation. The aim of the study was to measure the amount of MPH and the viscosity of the disintegrated solutions that were made from the four MPH formulations by four i.v.-users and non-users. METHODS A convenience sample of four i.v. substance users and 12 non-users. Non-users imitated the methods applied by experienced i.v. substance users for disintegrated MPH formulations. RESULTS Both groups managed to disintegrate over 50% of MPH from IR and SR formulations but only 20% from OROS (p<0.0001). The viscosity of the disintegrated MPH was significantly higher for MPH OROS and MPH OCR and the preparation was significantly more time-consuming than for the other MPH samples. No differences were observed between users and non-users. CONCLUSIONS To our knowledge, this is the first investigation of viscosity and the amount of disintegrated MPH from prescription drugs for i.v. use. The results indicate that the ease of disintegration, amount of MPH and viscosity may explain the difference in popularity for i.v. use between different MPH formulations.
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Affiliation(s)
- G D Bjarnadottir
- Mental Health Services, Landspitali - The National University Hospital, 101 Reykjavik, Iceland; Faculty of Medicine, Department of Psychiatry, University of Iceland, 101 Reykjavík, Iceland.
| | - M Johannsson
- Faculty of Medicine, Department of Pharmacology and Toxicology,University of Iceland, 107 Reykjavik, Iceland
| | - A Magnusson
- Department of Psychiatry, Akureyri Hospital, 600 Akureyri, Iceland
| | - B O Rafnar
- Mental Health Services, Landspitali - The National University Hospital, 101 Reykjavik, Iceland; Faculty of Medicine, Department of Psychiatry, University of Iceland, 101 Reykjavík, Iceland
| | - E Sigurdsson
- Mental Health Services, Landspitali - The National University Hospital, 101 Reykjavik, Iceland; Faculty of Medicine, Department of Psychiatry, University of Iceland, 101 Reykjavík, Iceland
| | - S Steingrimsson
- Centre for Ethics, Law and Mental Health (CELAM), Sahlgrenska Academy, The University of Gothenburg, 41677 Gothenburg, Sweden; Faculty of Medicine, Department of Psychiatry, University of Iceland, 101 Reykjavík, Iceland
| | - V Asgrimsson
- Faculty of Medicine, Department of Pharmacology and Toxicology,University of Iceland, 107 Reykjavik, Iceland
| | - I Snorradottir
- Faculty of Medicine, Department of Pharmacology and Toxicology,University of Iceland, 107 Reykjavik, Iceland
| | - H Bragadottir
- Mental Health Services, Landspitali - The National University Hospital, 101 Reykjavik, Iceland
| | - H M Haraldsson
- Mental Health Services, Landspitali - The National University Hospital, 101 Reykjavik, Iceland; Faculty of Medicine, Department of Psychiatry, University of Iceland, 101 Reykjavík, Iceland
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Hayley AC, Stough C, Downey LA. DSM-5 cannabis use disorder, substance use and DSM-5 specific substance-use disorders: Evaluating comorbidity in a population-based sample. Eur Neuropsychopharmacol 2017; 27:732-743. [PMID: 28663122 DOI: 10.1016/j.euroneuro.2017.06.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/23/2017] [Accepted: 06/10/2017] [Indexed: 11/30/2022]
Abstract
Cannabis use disorder (CUD) is frequently associated with concurrent substance use and/or comorbid substance use disorders (SUDs); however there is little specificity with regard to commonly abused individual drug types/classes. This study therefore aimed to provide insight into the degree of these co-occurring relationships across several specific newer and older generation illicit and prescription drugs. 36,309 adults aged 18+ from wave 3 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III) were assessed. Weighted cross-tabulations and multivariable logistic regression analyses were used to evaluate comorbidity between current DSM-5 CUD, substance use and DSM-5 SUD. Current DSM-5 CUD is associated with greater lifetime use of all examined drug classes, and previous 12-month use of several newer-class illicit and prescription stimulant-based substances (all p< 0.05). Current DSM-5 CUD was similarly associated with increased incidence of a range of DSM-5 SUDs and was independently associated with concurrently reporting current DSM-5; sedative (Adjusted OR= 5.1, 95%CI 2.9-9.0), cocaine (AOR= 9.3, 95%CI 5.6-15.5), stimulant (AOR= 4.3, 95%CI 2.3-7.9), club drug (AOR= 16.1, 95%CI 6.3-40.8), opioid (AOR= 4.6, 95%CI 3.0-6.8) and alcohol-use disorder (AOR= 3.0, 95%CI 2.5-3.7); but not heroin or 'other' drug use disorder (both p>0.05). High comorbidity exists between DSM-5 CUD and many specific DSM-5 SUDs. Newer-class illicit and prescription stimulant-based drug use disorders are overrepresented among those with DSM-5 CUD. These findings underscore the need for tailored treatment programs for those presenting with DSM-5 CUD, and for greater treatment specification where poly-drug use is evident.
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Affiliation(s)
- Amie C Hayley
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia.
| | - Con Stough
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia
| | - Luke A Downey
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia; Institute for Breathing and Sleep, Austin Hospital, Melbourne, Australia
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Hogue A, Evans SW, Levin FR. A Clinician's Guide to Co-occurring ADHD among Adolescent Substance Users: Comorbidity, Neurodevelopmental Risk, and Evidence-based Treatment Options. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2017; 26:277-292. [PMID: 30828239 PMCID: PMC6392461 DOI: 10.1080/1067828x.2017.1305930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
This article introduces neurodevelopmental and clinical considerations for treating adolescents with co-occurring Attention-Deficit/Hyperactivity Disorder (ADHD) and substance use (ASU) in outpatient settings. We first describe neurobiological impairments common to ADHD and ASU, including comorbidity with conduct disorder, that evoke a profile of multiplicative developmental risk. We then present two evidence-based options for targeting ADHD-related problems during ASU treatment. Medication integration interventions utilize family ADHD psychoeducation to prompt decision-making about ADHD medication and integrate medication management into behavioral services. Clinic-based academic training interventions utilize family interventions to improve the home academic environment and boost organization skills. We conclude with recommendations for ADHD assessment and intervention sequencing.
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Affiliation(s)
- Aaron Hogue
- National Center on Addiction and Substance Abuse, New York, NY, USA
| | | | - Frances R Levin
- Columbia University, New York, NY, USA, New York State Psychiatric Institute
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Blevins CE, Stephens R, Abrantes AM. Motives for Prescription Stimulant Misuse in a College Sample: Characteristics of Users, Perception of Risk, and Consequences of Use. Subst Use Misuse 2017; 52:555-561. [PMID: 28010163 DOI: 10.1080/10826084.2016.1245338] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Prescription stimulant misuse is increasingly prevalent in college populations, with some misuse estimates over 40%. Stimulant use is associated with a variety of health and psychological problems. Motives for use may provide insight into problematic trajectories. OBJECTIVES The purpose of the current study was to evaluate characteristics of users and motives for prescription stimulant misuse in a large southeastern university. METHOD College students reported on prescription stimulant use, motives for use, consequences associated with use, perceptions of risk, and social norms. We specifically elicited participation from prescription stimulant misusers. Of the 199 participants, 86 reported misusing prescription stimulants in the past 60 days. We assessed motives for use, rates of substance use, risk perception, normative beliefs, and consequences associated with use. We evaluated differences between misusers and non-misusers, differentiate motives subscales, and identify relationships between motives subscales, rates of use, and consequences. RESULTS Misusers used more alcohol and other drugs, held different normative beliefs regarding stimulants, and had lower risk perceptions than non-misusers. We evaluated seven motives subscales among misusers: coping, social, enhancement, expansion, conformity, academic performance, and weight loss. Enhancement, social, weight loss, and expansion scales were correlated with negative consequences, while social motives were correlated with use. Results from regression analyses revealed positive associations between weight and expansion with negative consequences, and a negative association between conformity and consequences. Conclusions/Importance:Motives for prescription stimulant use and user characteristics may provide insight into prevention and treatment. Continued work is needed to refine item content and replicate findings.
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Affiliation(s)
- Claire E Blevins
- a Department of Psychology , Virginia Tech , Blacksburg , Virginia , USA.,b Alpert Medical School of Brown University , Providence , Rhode Island , USA.,c Butler Hospital , Providence , Rhode Island , USA
| | - Robert Stephens
- a Department of Psychology , Virginia Tech , Blacksburg , Virginia , USA.,b Alpert Medical School of Brown University , Providence , Rhode Island , USA.,c Butler Hospital , Providence , Rhode Island , USA
| | - Ana M Abrantes
- b Alpert Medical School of Brown University , Providence , Rhode Island , USA.,c Butler Hospital , Providence , Rhode Island , USA
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Ghosh M, Holman CDJ, Preen DB. Identifying cross-cultural variations in psychostimulant use for attention deficit hyperactivity disorder using linked data. Child Adolesc Psychiatry Ment Health 2017; 11:16. [PMID: 28331541 PMCID: PMC5359967 DOI: 10.1186/s13034-017-0152-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 03/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To validate the association between country-of-birth and disparities in the stimulant use for ADHD among individuals in Western Australia. METHODS Using linked data, a population-based retrospective cohort of individuals admitted to hospital before age 25 years was followed through to identify having stimulants for ADHD in 2003-2007. Multivariate logistic and linear regressions were used to characterise associations between stimulants and country-of-birth, geographical remoteness and socioeconomic status. RESULTS Of 679,645 individuals, 14,122 (2.1%) had a record of having stimulants for ADHD. Of these, 205 (1.5%) were born in Africa, Asia, Middle-East or South America, while 13,664 (96.8%) were born in Australia/New Zealand, Europe or North America. Individuals with traditionally non-Anglophonic backgrounds were around one-half as likely to have stimulants as individuals with Anglophonic backgrounds (OR = 0.53, 95% CI 0.46-0.61, p < 0.001). Non-Anglophones were an average of 2.7 years older than Anglophones at onset of having stimulants. Individuals from remote and disadvantaged backgrounds had stimulants at younger ages than individuals living in metropolitan areas and with least disadvantage. CONCLUSIONS The results highlight the importance of identifying factors underlying cultural differences in stimulant treatment for ADHD. Improving awareness of cultural variations may foster trust and rapport between patients and clinicians, and so better facilitate the appropriate and effective treatment of ADHD for each patient.
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Affiliation(s)
- Manonita Ghosh
- 0000 0004 1936 7910grid.1012.2School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia
| | - C. D’Arcy J. Holman
- 0000 0004 1936 7910grid.1012.2School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia
| | - David B. Preen
- 0000 0004 1936 7910grid.1012.2School of Population Health, The University of Western Australia, 35 Stirling Highway, Crawley, WA 6009 Australia
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Groenman AP, Schweren LJS, Dietrich A, Hoekstra PJ. An update on the safety of psychostimulants for the treatment of attention-deficit/hyperactivity disorder. Expert Opin Drug Saf 2017; 16:455-464. [PMID: 28277842 DOI: 10.1080/14740338.2017.1301928] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Methylphenidate is the first-line pharmacological treatment of attention-deficit/hyperactivity disorder (ADHD). Although methylphenidate has a well-established evidence base for treating ADHD, its long-term benefits are unclear. Areas covered: Physical adverse effects, psychiatric adverse events and brain development Expert opinion: Some physical adverse events have been described (e.g. sleep disturbances, growth reduction, loss of appetite), although most are of transient nature. Psychiatric adverse events seem more related to the diagnosis ADHD itself, and not stimulant treatment. Concluding, short-to-mid-term use (i.e., up to 2 years) stimulants are relatively safe, but much less is known about longer-term efficacy and safety of these drugs.
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Affiliation(s)
- Annabeth P Groenman
- a Department of Child and Adolescent Psychiatry , University of Groningen, University Medical Center Groningen , Groningen , Netherlands
| | | | - Andrea Dietrich
- a Department of Child and Adolescent Psychiatry , University of Groningen, University Medical Center Groningen , Groningen , Netherlands
| | - Pieter J Hoekstra
- a Department of Child and Adolescent Psychiatry , University of Groningen, University Medical Center Groningen , Groningen , Netherlands
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Toce MS, Farias M, Bruccoleri R, Brown DW, Burns MM. A Case Report of Reversible Takotsubo Cardiomyopathy after Amphetamine/Dextroamphetamine Ingestion in a 15-Year-Old Adolescent Girl. J Pediatr 2017; 182:385-388.e3. [PMID: 27979580 DOI: 10.1016/j.jpeds.2016.11.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/17/2016] [Accepted: 11/09/2016] [Indexed: 12/20/2022]
Abstract
Stimulant medications are used in the treatment of attention deficit hyperactivity disorder and serious cardiac complications can occur when these medications are abused. We present a 15-year-old adolescent girl who was found to have a Takotsubo cardiomyopathy after acute amphetamine/dextroamphetamine ingestion.
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Affiliation(s)
- Michael S Toce
- Harvard Medical Toxicology Program, Boston Children's Hospital, Boston, MA.
| | - Michael Farias
- Department of Medicine, Division of Cardiology, Boston Children's Hospital, Boston, MA
| | - Rebecca Bruccoleri
- Harvard Medical Toxicology Program, Boston Children's Hospital, Boston, MA
| | - David W Brown
- Department of Medicine, Division of Cardiology, Boston Children's Hospital, Boston, MA
| | - Michele M Burns
- Harvard Medical Toxicology Program, Boston Children's Hospital, Boston, MA; Department of Medicine, Division of Emergency Medicine, Boston Children's Hospital, Boston, MA
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Jeanne G, Purper-Ouakil D, Rigole H, Franc N. [New patterns of substance use and abuse among French adolescents, a knowledge synthesis]. Encephale 2016; 43:346-353. [PMID: 27720453 DOI: 10.1016/j.encep.2016.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 05/23/2016] [Accepted: 05/25/2016] [Indexed: 10/20/2022]
Abstract
AIM There have been significant changes in adolescent consumption habits over the past fifteen years. New molecules have been synthesized, new devices created and a number of products have increased in popularity; and as a result clinicians sometimes lack information. We chose to focus on this population because of its vulnerability, as adolescents show low sensitivity to long-term outcomes of their actions and may be easily influenced by peers as regards experimentation of new drugs. The most consumed products by adolescents in France are tobacco, alcohol and cannabis with the physiological effects and consumption patterns of these drugs well documented. The purpose of this review is to identify and describe other products that are frequently used by adolescents to get high, to increase performance, for purposes of self-medication or because of peer pressure. We summarized the current scientific evidence regarding drug availability, physical and chemical properties, pharmacodynamics and adverse effects. METHOD A literature review was conducted from 2000 to 2015 based on Pudmed, Google Scholar and governmental websites, using the following keyword alone or in combination: "adolescent", "new", "misuse", "abuse", "toxicity", "pharmacology" "cocaine", "MDMA", "inhalant", "poppers", "magic mushroom", "psilocybin", "designer drug", "legal high", "smart drug", "cathinone", "mephedrone", "cannabinoid", "prescription drug", "codeine", "opioid", "methylphenidate", "cough syrup", "purple drank". RESULTS New products, including synthetic cannabis, cathinone or purple drank seem to be the most dangerous. They are easily accessible and may lead to short-term severe or lethal complications. Other substances do not pose a major short-term health risk by themselves. However, their consumption may be an indication of other unhealthy risk behaviors, such as prescription drug use, which may be related to psychiatric comorbidity. Unfortunately, we do not have enough data to determine the long-term consequences of the use of these substances. Moreover, these products have a strong addictive potential and may be a risk factor for other addictions. For this reason, increased supervision is justified, both for surveillance and reduction of harm. CONCLUSION Taking care of an adolescent with substance abuse can be difficult. Updated information regarding these new substances and the particular danger they pose to adolescent health is needed. Informed clinicians can provide up to date and accurate information to the patient and family, assess potential risk factors and comorbidities, and provide appropriate support. Furthermore, because of the high prevalence of substance abuse in the adolescent population, systematic screening of adolescent consumption habit is useful to avoid or anticipate complications. Often, problematic substance consumption behaviors are signs of more complicated psychological or psychiatric issues. Substance abuse behaviors will often disappear over time but they can also become a major problem as the adolescent moves into adulthood. If problems persist, consultation with an addiction specialist may be warranted.
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Affiliation(s)
- G Jeanne
- Service de médecine psychologique pour l'enfant et l'adolescent (MPEA), CHU Saint-Éloi, 80, avenue Augustin-Fliche, 34090 Montpellier, France.
| | - D Purper-Ouakil
- Service de médecine psychologique pour l'enfant et l'adolescent (MPEA), CHU Saint-Éloi, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - H Rigole
- Service de médecine interne et addictologie, CHU Saint-Éloi, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - N Franc
- Service de médecine psychologique pour l'enfant et l'adolescent (MPEA), CHU Saint-Éloi, 80, avenue Augustin-Fliche, 34090 Montpellier, France.
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Weyandt LL, Oster DR, Marraccini ME, Gudmundsdottir BG, Munro BA, Rathkey ES, McCallum A. Prescription stimulant medication misuse: Where are we and where do we go from here? Exp Clin Psychopharmacol 2016; 24:400-414. [PMID: 27690507 PMCID: PMC5113141 DOI: 10.1037/pha0000093] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Prescription stimulants, including methylphenidate (e.g., Ritalin) and amphetamine compounds (e.g., dextroamphetamine; Adderall), have been approved by the U.S. Food and Drug Administration for the treatment of attention-deficit/hyperactivity disorder (ADHD) and are classified by the United States Drug Enforcement Administration as Schedule II medications because of their high potential for abuse and dependence (Drug Enforcement Administration, U.S. Department of Justice, 2015). Despite the potential health and judicial consequences, misuse of prescription stimulants, typically defined as taking stimulants without a valid prescription, or use of stimulants other than as prescribed, has become a serious problem in the United States and abroad, especially on college campuses. The purpose of the present article is to review historical information concerning prescription stimulants and to summarize the literature with respect to misuse among adults, particularly college students, including risk factors, mediators and moderators, and motivations for prescription stimulant misuse. In addition, evidence is presented concerning the question of whether prescription stimulants truly enhance cognitive functioning in individuals with and without ADHD, and the ethical and professional implications of these findings are explored. Lastly, recommendations for addressing prescription stimulant misuse and suggestions for future research are advanced. (PsycINFO Database Record
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Gudmundsdottir BG, Weyandt L, Munro B. Prescription Stimulant Misuse: International Findings and Implications for Policy, Prevention, and Intervention. ACTA ACUST UNITED AC 2016. [DOI: 10.1521/adhd.2016.24.6.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Renoux C, Shin JY, Dell'Aniello S, Fergusson E, Suissa S. Prescribing trends of attention-deficit hyperactivity disorder (ADHD) medications in UK primary care, 1995-2015. Br J Clin Pharmacol 2016; 82:858-68. [PMID: 27145886 DOI: 10.1111/bcp.13000] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 04/28/2016] [Accepted: 04/30/2016] [Indexed: 12/25/2022] Open
Abstract
AIM The aim of the present study was to describe the prescription of medications for attention-deficit hyperactivity disorder (ADHD) in the UK between 1995 and 2015. METHODS Using the Clinical Practice Research Datalink (CPRD), we defined a cohort of all patients aged 6-45 years, registered with a general practitioner between January 1995 and September 2015. All prescriptions of methylphenidate, dexamphetamine/lisdexamphetamine and atomoxetine were identified and annual prescription rates of ADHD were estimated using Poisson regression. RESULTS Within a cohort of 7 432 735 patients, we identified 698 148 prescriptions of ADHD medications during 41 171 528 person-years of follow-up. Usage was relatively low until 2000, during which the prescription rate was 42.7 [95% confidence interval (CI) 20.9, 87.2] prescriptions per 10 000 persons, increasing to 394.4 (95% CI 296.7, 524.2) in 2015, corresponding to an almost 800% increase (rate ratio 8.87; 95% CI 7.10, 11.09). The increase was seen in all age groups and in both sexes but was steepest in boys aged 10-14 years. The prescription rate in males was almost five times that of females. Methylphenidate remained the most prescribed drug during the 20-year study period, representing 88.9% of all prescriptions in the 6-24-year-old group, and 63.5% of all prescriptions in adults (25-45 years of age). CONCLUSIONS Prescription rates of ADHD medications have increased dramatically in the past two decades. This may be due, at least in part, to both an increase in the number of patients diagnosed with ADHD over time and a higher percentage of those patients treated with medication.
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Affiliation(s)
- Christel Renoux
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada.,Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada.,Department of Epidemiology and Biostatistics, McGill University, Montréal, QC, Canada
| | - Ju-Young Shin
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
| | - Sophie Dell'Aniello
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
| | - Emma Fergusson
- The Clockhouse, Oxford Health, Oxford University, Oxford, UK
| | - Samy Suissa
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada.,Department of Epidemiology and Biostatistics, McGill University, Montréal, QC, Canada
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Skoglund C, Brandt L, Almqvist C, D’Onofrio BM, Konstenius M, Franck J, Larsson H. Factors Associated With Adherence to Methylphenidate Treatment in Adult Patients With Attention-Deficit/Hyperactivity Disorder and Substance Use Disorders. J Clin Psychopharmacol 2016; 36:222-8. [PMID: 27043119 PMCID: PMC4837023 DOI: 10.1097/jcp.0000000000000501] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Adherence to treatment is one of the most consistent factors associated with a favorable addiction treatment outcome. Little is known about factors associated with treatment adherence in individuals affected with comorbid attention-deficit/hyperactivity disorder and substance use disorders (SUD). This study aimed to explore whether treatment-associated factors, such as the prescribing physician's (sub)specialty and methylphenidate (MPH) dose, or patient-related factors, such as sex, age, SUD subtype, and psychiatric comorbidity, were associated with adherence to MPH treatment. Swedish national registers were used to identify adult individuals with prescriptions of MPH and medications specifically used in the treatment of SUD or a diagnosis of SUD and/or coexisting psychiatric diagnoses. Primary outcome measure was days in active MPH treatment in stratified dose groups (≤36 mg, ≥37 mg to ≤54 mg, ≥55 mg to ≤72 mg, ≥73 mg to ≤90 mg, ≥91 mg to ≤108 mg, and ≥109 mg). Lower MPH doses (ie, ≤36 mg day 100) were associated with treatment discontinuation between days 101 and 830 (HR≤36 mg, 1.67; HR37-54mg, 1.37; HR55-72mg, 1.36; HR73-90mg, 1.19; HR≥108mg, 1.09). The results showed a linear trend (P < 0.0001) toward decreased risk of treatment discontinuation along with increase of MPH doses. In conclusion, this study shows that higher MPH doses were associated with long-term treatment adherence in individuals with attention-deficit/hyperactivity disorder and SUD.
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Affiliation(s)
- Charlotte Skoglund
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Norra Stationsgatan 69, SE-113 64 Stockholm, Sweden
| | - Lena Brandt
- Center for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Lung and Allergy Unit, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Brian M. D’Onofrio
- Department of Psychological and Brain Sciences Indiana University, 1101 East 10th Street, Bloomington, IN 47405, USA
| | - Maija Konstenius
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Norra Stationsgatan 69, SE-113 64 Stockholm, Sweden
| | - Johan Franck
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Norra Stationsgatan 69, SE-113 64 Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Mantyh WG, Auger RR, Morgenthaler TI, Silber MH, Moore WR. Examining the Frequency of Stimulant Misuse among Patients with Primary Disorders of Hypersomnolence: A Retrospective Cohort Study. J Clin Sleep Med 2016; 12:659-62. [PMID: 26943713 DOI: 10.5664/jcsm.5788] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 12/13/2015] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Narcolepsy and idiopathic hypersomnia are commonly treated by sleep specialists and encountered by other medical providers. Although pharmacotherapy with modafinil and traditional stimulants is considered the mainstay of treatment, physicians are often uncomfortable with their prescription because of concerns regarding misuse. The goal of this study was to assess the frequency of stimulant misuse in this population. METHODS A retrospective cohort study was performed evaluating patients 18 years and older diagnosed with narcolepsy with and without cataplexy and idiopathic hypersomnia with and without long sleep between 2003-2008. Patients were included if they obtained stimulant prescriptions from and had at least one follow-up visit subsequent to initial diagnosis at our center. Stimulant misuse was defined by multiple prescription sources or early refill requests, which are systematically entered into the record by nursing staff. RESULTS A total of 105 patients met inclusion criteria for the study; 45 (42%) were male. Mean age at multiple sleep latency test was 42 (± 16). Twelve (11%) patients had a history of illicit substance misuse, and one (1%) patient demonstrated previous stimulant misuse. Fifty-seven (54%) patients carried psychiatric diagnoses, 88% of whom reported depression. Median duration of monitored stimulant therapy was 26 months (range 1-250). None of the 105 patients was found to have evidence of stimulant misuse. CONCLUSION This study suggests that the frequency of stimulant misuse in patients with narcolepsy and idiopathic hypersomnia is extremely low. Concerns regarding drug misuse should not leverage decisions to provide long-term therapy.
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Affiliation(s)
| | - R Robert Auger
- Center for Sleep Medicine, Mayo Clinic, Rochester, MN.,Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN
| | - Timothy I Morgenthaler
- Department of Internal Medicine, Mayo Clinic, Rochester, MN.,Center for Sleep Medicine, Mayo Clinic, Rochester, MN.,Division of Pulmonary & Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Michael H Silber
- Center for Sleep Medicine, Mayo Clinic, Rochester, MN.,Department of Neurology, Mayo Clinic, Rochester, MN
| | - Wendy R Moore
- Center for Sleep Medicine, Mayo Clinic, Rochester, MN
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Bjarnadottir GD, Haraldsson HM, Rafnar BO, Sigurdsson E, Steingrimsson S, Johannsson M, Bragadottir H, Magnusson A. Prevalent intravenous abuse of methylphenidate among treatment-seeking patients with substance abuse disorders: a descriptive population-based study. J Addict Med 2016; 9:188-94. [PMID: 25748561 PMCID: PMC4450903 DOI: 10.1097/adm.0000000000000115] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objectives: Prescription rates of methylphenidate (MPH) are sharply rising in most Western countries. Although it has been reported that MPH has abuse potential, little is known about the prevalence of intravenous (IV) abuse of MPH. The aim of the study was to investigate the prevalence of IV MPH abuse among treatment-seeking IV substance abusers in Iceland. Methods: This is a descriptive population-based study using a semistructured interview assessing sociodemographics, substance abuse history, and the method of administration of 108 IV substance abusers. During 1 year, consecutively admitted adult inpatients with substance use disorder at any detoxification center in Iceland that reported any IV substance abuse in the past 30 days were invited to participate. Abuse was defined as nontherapeutic use of a substance to gain psychological or physiological effect. Results: Prevalence of any IV MPH abuse among participants was 88% in the last 30 days (95% confidence interval [CI], 0.82-0.94) and MPH was the most commonly abused substance (65%) and the preferred substance (63%). Around one third (30%) reported MPH as the first IV substance ever abused. However, among those reporting a shorter history than 10 years of IV abuse, 42% reported MPH as the first IV substance ever abused. Conclusions: This first nationwide study on IV abuse of MPH shows that it is common among treatment-seeking IV abusers in Iceland and suggests that MPH has high abuse potential. Therefore, both the use and possible abuse of MPH in those with high abuse potential should be monitored, especially in countries where MPH prescriptions rates are on the rise.
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Affiliation(s)
- Gudrun D Bjarnadottir
- From the Mental Health Services, Landspitali-the National University Hospital (GDB, HMH, BOR, ES, HB), Reykjavik, Iceland; Centre for Ethics, Law and Mental Health (SS), Institute of Neuroscience and Physiology, The Sahlgrenska Academy, The University of Gothenburg, Gothenburg, Sweden; School of Health Sciences (GDB, HMH, BOR, ES, AM), Faculty of Medicine, University of Iceland, Reykjavík, Iceland; and Department of Pharmacology and Toxicology (MJ), Faculty of Medicine, University of Iceland, Reykjavik, Iceland
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Cairns R, Daniels B, Wood DA, Brett J. ADHD medication overdose and misuse: the NSW Poisons Information Centre experience, 2004–2014. Med J Aust 2016; 204:154. [DOI: 10.5694/mja15.00791] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 12/24/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Rose Cairns
- NSW Poisons Information Centre, The Children's Hospital at Westmead, Sydney, NSW
| | | | | | - Jonathan Brett
- University of Sydney, Sydney, NSW
- Drug Health Services, Royal Prince Alfred Hospital, Sydney, NSW
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Jensen C, Forlini C, Partridge B, Hall W. Australian University Students' Coping Strategies and Use of Pharmaceutical Stimulants as Cognitive Enhancers. Front Psychol 2016; 7:277. [PMID: 26973573 PMCID: PMC4771940 DOI: 10.3389/fpsyg.2016.00277] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 02/12/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There are reports that some university students are using prescription stimulants for non-medical 'pharmaceutical cognitive enhancement (PCE)' to improve alertness, focus, memory, and mood in an attempt to manage the demands of study at university. Purported demand for PCEs in academic contexts have been based on incomplete understandings of student motivations, and often based on untested assumptions about the context within which stimulants are used. They may represent attempts to cope with biopsychosocial stressors in university life by offsetting students' inadequate coping responses, which in turn may affect their cognitive performance. This study aimed to identify (a) what strategies students adopted to cope with the stress of university life and, (b) to assess whether students who have used stimulants for PCE exhibit particular stress or coping patterns. METHODS We interviewed 38 university students (with and without PCE experience) about their experience of managing student life, specifically their: educational values; study habits; achievement; stress management; getting assistance; competing activities and demands; health habits; and cognitive enhancement practices. All interview transcripts were coded into themes and analyzed. RESULTS Our thematic analysis revealed that, generally, self-rated coping ability decreased as students' self-rated stress level increased. Students used emotion- and problem-focused coping for the most part and adjustment-focused coping to a lesser extent. Avoidance, an emotion-focused coping strategy, was the most common, followed by problem-focused coping strategies, the use of cognition on enhancing substances, and planning and monitoring of workload. PCE users predominantly used avoidant emotion-focused coping strategies until they no longer mitigated the distress of approaching deadlines resulting in the use of prescription stimulants as a substance-based problem-focused coping strategy. CONCLUSION Our study suggests that students who choose coping responses that do not moderate stress where possible, may cause themselves additional distress and avoid learning more effective coping responses. Helping students to understand stress and coping, and develop realistic stress appraisal techniques, may assist students in general to maintain manageable distress levels and functioning. Furthermore, assisting students who may be inclined to use prescription stimulants for cognitive enhancement may reduce possible drug-related harms.
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Affiliation(s)
- Charmaine Jensen
- Centre for Youth Substance Abuse Research, Royal Brisbane and Women's Hospital Brisbane, QLD, Australia
| | - Cynthia Forlini
- University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital Campus, The University of Queensland Brisbane, QLD, Australia
| | - Brad Partridge
- Centre for Youth Substance Abuse Research, Royal Brisbane and Women's Hospital Brisbane, QLD, Australia
| | - Wayne Hall
- Centre for Youth Substance Abuse Research, Royal Brisbane and Women's Hospital Brisbane, QLD, Australia
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Kuehn MB, Hotho D, Prunty M. Parental Consent for Adolescent Research. Creat Nurs 2016; 22:51-55. [PMID: 30188306 DOI: 10.1891/1078-4535.22.1.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this article is to increase understanding about how to obtain institutional review board approval to waive parental consent for adolescent research that involves minimal risk to subjects and/or that cannot be carried out practicably without the waiver. Because of IRB guidelines, the researchers were unable to use passive parental consent for a study of adolescent nonmedical prescription drug use (NMPDU). Without knowledge of waiver 45 C.F.R. §46.116 of the U.S. Department of Health and Human Services Code of Federal Regulations regarding the protection of human research subjects, the study design required active parental consent for survey administration. This requirement limited study participation and increased costs. Using the waiver, the study design could have waived parental consent with adolescent assent. By increasing awareness of the 45 C.F.R. §46.116 waiver and its subparts, the researchers hope to inform future researchers about reducing barriers to future adolescent research. Lessons learned include how using the waiver may decrease research costs, reduce participant selection bias, increase participant response rate, and expand data available to contribute to critical, emerging adolescent health issues such as NMPDU.
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49
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Robitaille C, Collin J. Prescription Psychostimulant Use Among Young Adults: A Narrative Review of Qualitative Studies. Subst Use Misuse 2016; 51:357-69. [PMID: 26886251 DOI: 10.3109/10826084.2015.1110170] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Within the last decade, the nonmedical use of prescription drugs has raised concern, particularly among young adults. Psychostimulants, that is to say amphetamine and its derivatives, are pharmaceuticals, which contribute to what has come to be known in Canada and the United States as the "prescription drug crisis." Research in the fields of public health, addiction studies, and neuroethics has attempted to further understand this mounting issue; however, there is a paucity of data concerning the underlying social logics related to the use of these substances. OBJECTIVES The objective of this article is to provide an overview of the current literature related to the social context of prescription psychostimulant use among young adults, and to discuss theoretical considerations as well as implications for future research. METHODS A narrative review of the literature was performed. RESULTS We found that research efforts have chiefly targeted college students, yet there is a lack of knowledge concerning other social groups likely to use these pharmaceuticals nonmedically, such as persons with high strain employment. Three main emerging patterns related to prescription psychostimulant use were identified: (1) control of external stressors, (2) strategic use toward the making of the self, and (3) increasing one's performance. CONCLUSIONS Prescription psychostimulant use among young adults is anchored in contemporary normativity and cannot be separated from the developing performance ethic within North-American and other Western societies. We suggest that pharmaceuticalization and Actor-Network Theory are useful conceptual tools to frame future research efforts.
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Affiliation(s)
- Caroline Robitaille
- a Social and Preventive Medicine, University of Montreal , Montreal , Canada
| | - Johanne Collin
- b Faculty of Pharmacy, University of Montreal , Montreal , Canada
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Rasmussen L, Zoëga H, Hallas J, Pottegård A. Deviant patterns of methylphenidate use in adults: a Danish nationwide registry-based drug utilization study. Pharmacoepidemiol Drug Saf 2015; 24:1189-96. [PMID: 26278467 DOI: 10.1002/pds.3852] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 06/29/2015] [Accepted: 07/15/2015] [Indexed: 11/11/2022]
Abstract
PURPOSE Several survey studies have documented misuse of methylphenidate defined as the use of non-prescribed methylphenidate or use different from what was prescribed. We aimed to identify and characterize adults with deviant patterns of methylphenidate use in Denmark during 2007-2012. Further, we aimed to identify risk factors associated with deviant patterns of use. METHODS Based on individual-level prescription data, new users of methylphenidate were followed for one year after filling their first prescription on methylphenidate. Adult patients were identified with deviant patterns of use if they had ≥4 different prescribers and filled ≥1095 defined daily doses of methylphenidate during the year of follow-up. Risk factors were estimated by using logistic regression. RESULTS Among 20 829 new users of methylphenidate, we identified 82 (0.39%) patients displaying deviant patterns of use. Characteristics associated with deviant patterns of use included an initial prescription for extended-release methylphenidate (OR2 4.35), age 25-49 years at first prescription (OR2 2.49), general practitioners or hospital doctors as initial prescribers (OR2 3.06 and OR2 4.07) and prior use of drugs used in addictive disorders (OR2 2.08) or opioids (OR2 1.75). Sensitivity analyses revealed that the number of different prescribers alone does not seem to effectively identify deviant users of methylphenidate. CONCLUSION We have identified characteristics associated with deviant patterns of methylphenidate use. Our results do not allow us to conclude if deviant users truly represent medical misusers.
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Affiliation(s)
- Lotte Rasmussen
- Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Helga Zoëga
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Jesper Hallas
- Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Anton Pottegård
- Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Odense C, Denmark
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